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BUILDING. INSPECTOR RECORD S!TE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DEI,CARATION I hwby affm unds pcnalty of pqjury thst I m cxcmpt ftom thc CotrtractoB' LiccE [aw for thc following |ten (Sc.7031.5 Buins md Profsion Code): Any City or County which rcquir6 a pqmh to coGtruct, altq. imprcvg danolish or rcpair my strucluc' prior to its issuocc, also rcquiro thc eplicmt for such Fmit to filc a signcd stalmat that hc or she is licascd p|lMt to the provisioB of thc Cotrurctor's Liccnscd t w (Chaptq 9, Comencing with Sction 7000 of Division 3 of thc BuinB ud Prcfeions Codc) or rhat hc or shc is qcmpt thscfrom and thc basis for thc allcgcd umpion. Aly violatiol of Scrion 703 I .5 by ey applicut for a pcrmit subjets the applicut to a civil pmalty of not more thm five hundrcd dollffi ($500). -1. as owner of thc p,ropcrty, or my cmployeâ‚¬s with wagcs as thcir sole compcrsation. will do the work and thc stnrcture is not intcnded or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves theron. and who does such work himself or hersclf or through his or her own employees, provided that such improvonents are not intandod or offired for sah. lf, howorer, the building or improvement is sold within one ]â‚¬ar of complaiorL the Orvner Builder will have thc burden of proving that he or she did not build or irnprove the propoty for the purposc of sale). -1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and hofissbn Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contracto(s) licaued pursuant to the Contractor's License t aw). -l arn exempt undcr Section_, B. & P.C. for this reason. Dete: WORKERS' COMPENSATION DECLAIIATION I hoeby affrm under penalty of perjury one of the following dcclarations: -l havc and will maintain a Certificate of Consent to Self-lnsure for worketrs' compcnsation, as p,rovided for by Section 3700 of the I-abor Code, for the performance of thc work for which the perrnit is issued. _l havc and 3700 of the Labor Codc, for thc pcrfonnance of the work for and policy number are: I Policy -l certi$ that in the performance of the work for which this permit is issued. I shall not ernploy any person in any manner so as to become subject to the worters' compcnsation laws of California. and agree that if I should bccome subject to the and the 0 t I hcrcby aflirm under poralty of pojury that I am licqrscd undcr p,rovision of Chapter 9 (commencing with Section 7000) of Division 3 of thc Busincss and Profcssions Code. and my license is in full forcc and effect, License Number:7 n W I hotby alfm mds pcnaly of pcrjury that th@ is I condruction knding agocy for thc pqforrmcc of thc rcrk for which this pqnh ii issucd (Sc. 3097, Civ. C.). Lender's Name: I-cnder's Address: APPLICANT DECI,IIRATION I hody affim unds poalty of pcrjury onc of thc followiag dclararions: Dcrnolition Pmits-AsbBtos Notificstiotr Fcd(al Rcfulstios (Titlc 40, Put6) -Rcquircd Lrtts of Notificdion . x cdiry that thc fcdoal rcgulatiom rcgrding ubctos moval uc not applicablc to this prcjâ‚¬l. >l cdiry that I havc Bd this application ad stalc thst thc sbovc infonnation is concl. I agrc to @mply with 8tl City ed Couty ordinmcG ed Statc [:w rclaling to building costruction, ard h@by authoria rcprBstativd of this City 8d Couty to otq upon thc abovc mertioncd propcrty for Applicant or Agent Permitee nrtnre purposes. sctL o*", (e/t(>( Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/Ve nUI ns u lation Roof Sheathing Shear Wall Framing lnsulation/Energy Drvwall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif FINAL /6-2sa( a Certificate of Occupancy Notes, Remarks, Etc.